Electronic Medical Records
This proposal seeks to address the issue of information technology integration into the medical or health fields in the United States. Specifically, it addresses the policies and frameworks dealing with the adoption of electronic medical records. It begins by defining the major problems related to medical and health information systems that existed prior to the advent of information technology. Thereafter, it traces a historical path that outlines the origin and the development of the problem. The proposal also adopts an international perspective in which the U.S. situation is compared with other countries across the world. Importantly, addressing this medical issue is based on the needs of the stakeholders in the health industry. The proposal addresses the successes and failures of the various points of focus with regard to particular stakeholders. To harmonize the question of information technology use, policies are put in place. As a result, the proposal delves on the impact of the federal policies such as the P.P.A.C.A. and others. On the basis of the evolution of the problem and the impacts made so far, several recommendations are put forward and expected outcomes envisaged. From the onset, it must be noted that although the adoption of electronic medical records face several challenges, it has made significant strides in improving the country’s healthcare delivery system.
Statement of the Problem
Medical care plays a very significant role in any country. In the U.S., the health sector has been faced with various challenges over time. These challenges have been translated into poor service delivery to patients. Specifically, keeping of medical records have posed serious health delivery problem. Due to the old ways of filing of paper records, it has always proved a difficult affair to trace them whenever they are urgently needed. There has been a lot of ineffectiveness in the overall service delivery in public hospitals. Although information technology took ground a bit earlier, the government has not been able to adopt an electronic system of records storage until a few years ago. There is no doubt that a radical and overhaul system of electronic health records (EHRs) is required for a more efficient system of service delivery. As a result, the United States Department of Health and Human Services Office of the National Coordinator for Health Information Technology together with the other organs of the government, especially the law making bodies, have been at the forefront of seeing to it that there is less paperwork in storage and sharing of health information.
History of the Problem
The problem of health records has long halted the delivery of healthcare in the U.S. The major aspects of this problem are storage and sharing of health-related information. Although this problem goes back to the days of the founding of the nation, only the most relevant aspects, in terms of time, will be outlined. The most significant leaps were made in the 1950’s when computers and internet were discovered. In fact, the initial computers to be designed, the mainframes, were designed for specific purposes such as healthcare management, weather forecasting among other specialized topics. As time went by and as technology advanced, personal computers were improvised. These were seen as the initial steps in the emergence of electronic management of health information. In the last two decades, the U.S. has seen a reduced use in paper records.
The history of healthcare reform may also be traced on the basis of laws and policies that are relevant and related to the reform in terms of information storage, sharing and security. In 1965, Medicare and Medicaid were passed. However, these two were not expressly addressing the issue of information technology. This issue may be said to have come up during the 2008 Democratic presidential primaries. After President Obama was elected president, he called a Congressional meeting in February 2009 to discuss the reform of health sector. Although many things were to be changed, of importance is the information technology. After a rigorous process of discussion, debates, lobbying and amendments, PPACA was finally signed into law in March 2010. In the final analysis, there was a formation of a system of health information technology (HIT) that highly reduced paper work and improved information sharing. However, although these two objectives were attained, today the reform agenda is faced with issues of information security.
Although the United States of America has been a leader in most policy issues, the country has often been overtaken by other nations as far as other issues are concerned. With regard to health, U.S. has done relatively better than most countries. Moreover, other countries have had better results on the basis of adoption of what could be termed to as ‘better’ models of health care reform and delivery.
To effectively understand the aspect of health information technology, there is a need to inspect the global health information systems, what is popularly called health informatics. It is seen as the intersection of healthcare and computer science. It involves the use of computer applications in order to process information related health. As early as 1949, Germany had already established an organization on informatics. In the UK, the health information reform is handled by the UK Council of Health Informatics. For many decades, the council has had the following sub-disciplines: health informatics service management, program and portfolio management, knowledge management and health records management.
Other countries have also had health information technology establishments. In Argentina, the Buenos Aires Biomedical Informatics Group was formed in order to help in the implementation of computer use in healthcare, help the interaction of scientists under health sector and promote training of health professionals in computer programs. In Brazil, application of computers in healthcare delivery began in 1968. The first mainframes were installed in institutions of higher learning and research. In 1996, the Brazilian Congress of Health Informatics was formed. It sought to coordinate efforts of entrenching information systems and systems of health record keeping in the country and was backed up by research efforts from the Federal University of Sao Paulo. Canada was not left behind too. In 2001, the Canada Health Infoway was formed, a non-profit organization to oversee. In 2003, Alberta Healthcare was also formed (Diamond, 2007) while in 2008, eHealth Ontario was formed. All these Canadian institutions sought to modernize healthcare delivery in various ways. In Europe, the European Union commissioned the European Institute for Health Records to play a leading role in coordinating the various health records systems.
All regions of the world have seen an adoption of electronic health records. In Oceania, New Zealand and Australia have formed a regional body that handles health informatics. This organization is called Asia Pacific Association for Medical Informatics (APAMI). Since its inception in 1994, 15 Asia Pacific region countries have joined the body and adopted its propositions in healthcare information technology management. In a special way, each country, just like the U.S., has sought to entrench provisions of health information management into law. In the same way, research has also played a key role in coming up with systems of healthcare information management. This is perhaps why the U.S. is not the leading country as far as health records keeping is concerned: because it is not the leader in research on health informatics. In Australia, the Australian College of Health Informatics (ACHI) handles such research. It is a member of the International Medical Informatics Association (IMIA). In 2009, the college played a key role in the formation of the Australian Health Informatics Education Council.
China, Hong Kong, India and Saudi Arabia also have systems of patient records management. As a result, they have formed Clinical Management System for Hong Kong, Indian Association of Medical Informatics, Saudi Association for Health Information, and Health Informatics New Zealand among others.
The health sector has many stakeholders or players. These are identified on the basis of the services offered by or purposes of the player. These stakeholders could be divided into four major categories: those who pay those who are treated, who provide it, those who control and those who employ. Therefore, the major stakeholders are the patients who are the citizens, the government of the U.S., the professional, the licensing bodies, protective associations, medical schools, labor unions, students and insurance companies.
Each stakeholder plays an important role in the wider delivery of healthcare. The patients play an important role because they are the ones who are actually treated. With regard to them, the major concerns are affordability and quality. The PPACA seeks to provide affordable healthcare for all. The other player, connected with the payment of the health bills is the government and the insurance companies. The latter are private but the government, under PPACA, has the sole mandate of providing affordable healthcare to all Americans in spite of their race, economic class or social status. Moreover, the insurance companies also have a big role since they also pay for medical bills. At the moment of PPACA passage, the insurance companies were instrumental in the debate. They is because they would benefit from the government funding.
The government is a major stakeholder in health and healthcare reform because it has not only a regulative but also a financing role. These roles are implemented in the context of various departments and ministries. The government also cuts across as an employer. Although there are private employers, the government plays a bigger role in ensuring that the professionals working in the health sector are well remunerated. In addition, the licensing organizations have a big stake because they set the standards of attainment and achievement for medical and health practitioners. Labor unions also fight and push for the rights of practitioners while medical schools teach students on how to become professional practitioners.
In order to effectively deal with the challenges several policy and legislative efforts have been made. The most significant ones are the Patient Protection and Affordable Care Act (P.P.A.C.A.) and the Health Care and Education Reconciliation Act. By focusing on the PPACA, it becomes apparent that the law, popularly referred to as ‘Obamacare’, there are various health reform issues that are addressed (The Office of the National Coordinator for Health Information Technology. 2012). Moreover, this proposal focuses on the information technology-related reforms that give a framework for the adoption and entrenchment of electronic health records and sharing of information. Although PPACA while be completed in 2020, its initial stages have been implemented so far. As a result, several impacts have been made. These impacts are no doubt related to the objectives and goals of the piece of the legislation. This proposal highlights impacts related to information technology gains and challenges.
Since PPACA was passed into law, health information storage, dissemination and security has been achieved on the following: insurance records, insurance premiums record keeping, and healthcare spending trends among others. In a special way, the law has seen great impacts in the expansion healthcare information sources, decreased paperwork, reduced healthcare costs, increased administrative efficiency, improved healthcare quality and prevention of medical errors. In addition, through information technology, it has been possible for the health institutions to trace and effectively manage chronic diseases, to easily detect infectious diseases and to evaluate healthcare impacts on the basis of emergent trends and quality information that is at the disposal of each healthcare information and research center (Coppel, 2005). The efficiencies that have come with the passage of PPACA are based on faster information processing by computers, reliable information transfer through internet, excellent information management using health information systems and enhanced information storage following security applications.
Having established that there are various stakeholders in the health sector, it is recommended that all of them be involved in the implementation of the health reforms. The government, which is at the middle of the health agenda, must always facilitate the implementation of the law. With respect to PPACA, the government must also always deliver its financial and funding obligations in a timely manner so that by 2020, all provisions will be implemented. However, since there have always been tensions between the Democrats and Republicans, there is a need to see full implementation of PPACA. It is on record that Republicans have vowed to repeal ‘Obamacare’ due to its alleged financial constrains it puts on government. There should also be better remuneration for health care delivery professionals such as doctors so that through the labor unions, they do not go on strike thus leading to a stagnation of the benefits that would otherwise flow from the PPACA provision. Finally, there should be continued research into the computer application, information systems and patient record storage systems.
The advent and rise of computers has led to unmatched improvements in the delivery of healthcare reform not only in America but also beyond. Over time, healthcare delivery has been sabotaged by the fact that systems of record keeping have been too poor to be effective. As a result, evolution of computers has led to better storage facilities as well as information sharing platforms. However, the main challenge facing electronic health records is the issue of security. Moreover, if all stakeholders are involved, there would be much easier implementation. In the final analysis, although there have been many challenges, the information technology provisions of the PPACA have led to improved healthcare delivery.